Nokardiose als Differenzialdiagnose eines PET-positiven Lungenherdes

Zusammenfassung

Wir beschreiben den Fall eines 76-jährigen immunkompetenten Mannes mit dem klinischen und radiologischen Verdacht auf ein Bronchialkarzinom im rechten Oberlappen. Der Tumor ließ sich transbronchial histologisch nicht sichern und zeigte im FDG-PET mit 13,4 ein deutlich erhöhtes „standard uptake value” (SUV). Der Tumor wurde mittels Thorakotomie reseziert und der histologische Befund ergab eine chronisch-karnifizierende Pneumonie. In dem Gewebe ließen sich mikrobiologisch in der Kultur Nokardien nachweisen. Die weitere Differenzierung mittels 16-rDNA-Gensequenzierung ergab Nocardia abscessus. Unter der resistenzgerechten, sequenziellen Therapie mit Trimethoprim-Sulfamethoxazol kam es im Verlauf zur deutlichen klinischen und radiologischen Befundbesserung.

Abstract

We describe the case of a 76-year-old immunocompetent man suspected to have lung cancer in the right upper lobe on the basis of radiographic and clinical findings. The tumour could not be confirmed histologically by transbronchial biopsy. In the fluorodeoxyglucose positron emission tomography (FDG-PET) we found a significantly elevated standard uptake value (SUV) of 13.4. The patient underwent thoracotomy with excision of the tumour, the histological diagnosis was chronic pneumonia. Tissue culture revealed Nocardia spp. Using 16-rDNA-gene sequence analysis the species was identified as Nocardia abscessus. The patient was treated with trimethoprim-sulfamethoxazol regarding the susceptibility profile and improved remarkably both clinically and radiographically.

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